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General NPI Number Information
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NPI Number | 1457535908
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Entity Type | Organization
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Legal Business Name | DOUGLAS GUTHRIE JR DPM
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Dates
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Enumeration Date | 12/19/2007
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Last Update Date | 12/26/2007
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Provider Practice Location Address
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Address Line | 514 S BONHAM ST SUITE B
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City | MEXIA
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State | TX
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Zip | 76667-3600
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Country | US
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Telephone | 254-562-7999
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Fax |
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Provider Business Mailing Address
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Address Line | 3200 CREEKWOOD CIR
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City | WACO
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State | TX
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Zip | 76710-1350
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Country | US
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Telephone | 254-562-7999
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DOUGLAS GUTHRIE JR.
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Credential | DPM
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Telephone | 254-562-7999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number | 00194
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License Number State | TX
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